Encouraging Black Women to Embrace Breastfeeding

American mothers as a whole do not breast-feed their babies as much as health experts would like, but African-American moms have the lowest rates of all — by some measures, they are half as likely to nurse as whites and Hispanics.

The federal government, some hospitals and nonprofits are trying different strategies to close this nursing gap, though no one seems sure exactly why the disparity exists.

Changing Perspectives

When Kathi Barber gave birth a decade ago, she was the first in her family in generations to nurse, and was dumbfounded to realize she had no role models. Barber became obsessed with encouraging nursing among black moms, as numerous studies show that exclusive breast-feeding can reduce a baby's chances of developing diabetes, obesity, ear infections and respiratory illness.

Yet Barber was frustrated that for many new mothers, their only image of this age-old act may come from a museum or a National Geographic documentary.

"Tribal women, with elongated breasts, earrings and tribal jewelry. And let's say we're trying to promote that to a 25-year-old, mmm ..." she laughs. "I don't think that's going to do the trick."

Nursing Rates And Demographics

For children born in 2006, a smaller percentage of African-American women exclusively breast-fed for three months.

Source: Centers for Disease Control and Prevention; Credit: Stephanie d'Otreppe/NPR

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Partnership And Peer Counseling

"People tell me it hurts," says 16-year-old Dijonna Hunter, due with her first child in February. But at the Developing Families Center in northeast Washington, D.C., where she's come for her maternal care, Hunter has learned about the health benefits of nursing. Hunter says she's determined to try it despite what her friends and mother tell her.

Experts say a supportive partner is key for successful breast-feeding, and Hunter's boyfriend, Anthony Frost, is trying. He's even taken to watching baby shows on television. But when asked if his mother nursed him, Frost makes clear that he finds the very notion disgusting. Angela Ewing-Boyd, the center's program manager, says she hears that a lot, even from women.

People say, "I can't imagine doing that to my child, and that's just nasty," she says. "It's like the primary function of the breast is one-dimensional."

So Ewing-Boyd has organized weekly peer-counseling sessions for pregnant women. On a recent afternoon, about a dozen of them sat in a circle, shifting to find a comfortable position on their folding chairs.

"I have a car," said counselor Joan Brickhouse, holding up a matchbox racer. "What does this have to do with breast-feeding?" She sent the car zooming across the floor as the women tossed out guesses — some sincere, a few snarky.

Brickhouse then told them, "You can take your breasts with you anywhere. On the airplane, you know, you can just whip it out!"

Other objects in this educational pop quiz stressed the health benefits of nursing and the economic advantage: breast milk, of course, is free, while formula can easily run $150 and more a month, which makes it all the more baffling why lower-income mothers of all races are more likely to choose formula.

In fact, the older, more educated and higher-income a mother is, the more likely she is to breast-feed. But experts say the disparity for African-Americans is so great it transcends socio-economics.

Barber says work is clearly a huge barrier, and black moms may be more likely to hold lower-wage jobs with no breaks allowed for nursing. African-Americans have also had to earn money since long before the women's liberation movement.

In fact, Barber thinks you can trace part of the problem all the way back to the breakup of families under slavery, and the enduring, negative image of so-called mammies — slaves made to serve as wet nurses for their master's white children.

That practice continued for domestic servants well past the end of slavery, and for Barber, it helps explain the ironies that played out later. In the 20th century, it was white, wealthy women who led the march to formula feeding, and minorities followed. But when white elites backtracked and made breast-feeding hip, most African-Americans didn't buy it.

"Infant formula became a thing of prestige," says Barber. "Breast-feeding was thought to be something that lower-class women did. So, if you can think of it as a political issue, it really is."

From Formula To Breast

Barber and others say another factor in low breast-feeding rates is aggressive marketing by the multibillion-dollar baby formula industry, which has convinced hospitals to hand out its products for free.

Barbara Philipp is medical director of the Birth Place at Boston Medical Center, and says numerous studies have looked at this.

"When I, as a physician in a white coat, or when a staff nurse with her hospital badge on, hand out that diaper bag that we get for free from the formula company," she says, "that mom and baby will go on to exclusively breast-feed for a shorter period of time."

A decade ago, Boston Medical Center launched a broad campaign to promote breast-feeding. It educated both its staff and clients. It started putting newborns in the same room with their mothers instead of carting them off to the nursery. And it stopped handing out free formula, something Philipp says caused a ruckus.

"It was seen as denying a free gift to poor women," she says.

But the number of mothers at the center who start out nursing has shot up to 90 percent, well above the national average for black mothers.

In fact, national rates have been rising for African-Americans — a study last year found that the number initiating breast-feeding had jumped from 36 percent in 1993-1994 to 65 percent in 2005-2006.

But that number still lags far behind whites and Hispanics, and figures from the Centers for Disease Control and Prevention show the proportion who continues nursing exclusively soon plunges into single digits. Washington's Developing Families Center tries to stem this drop with follow-up visits to new moms.

Home Visit Lends Support

Counselor Tina Pangelinan steps into Kala Blue's small apartment five days after Blue delivered baby Kamya.

For the past two days, an exhausted Blue has struggled to get Kamya to latch on, and has instead been using the free formula the hospital gave her. The women sit side by side on the love seat as Pangelinan offers tips and suggestions, and Blue tries again and again, holding her frustrated baby first one way and then another.

Finally, after 20 long minutes, she succeeds. But Blue admits it just doesn't feel right. Pangelinan offers to come back tomorrow with a breast pump, so Blue can express her milk into a bottle.

"We're here for you," she tells Blue.

Whatever it takes to keep one more African-American baby getting mother's milk.

Lisa Uncles, a certified nurse-midwife who is the acting clinical director of the Family Health and Birth Center in Washington, D.C., visits a new mother a day after she gave birth. Clients of the center have fewer premature births, low birth weights and cesarean sections as compared with the D.C.'s African-American population overall.

Public health officials have waged two campaigns to promote breast-feeding in the U.S. The first was a century ago, when infant deaths from diarrhea were linked to spoiled, diluted or unpasteurized cow's milk in baby formula. The other was earlier this decade, when the Health and Human Services Department called for a mass-marketing effort to promote not just the benefits of breast-feeding, but the dangers of formula feeding. That led to two U.S. television ads.

A friend of mine just came back from South Africa. She has been to a traditional village without electricity etc, but in the local "store", they sold formula and when she asked a local woman, how long they would breastfeed, she was given 3-6 months as an answer."Infant formula became a thing of prestige," says Barber (of the cited text). That's exactly the problem.

I think, perhaps a lot of the poorer outcomes in coloured women, come from those in places where white people spent some time in history treating them poorly? A lack of education and support in their mothers mothers times? I have no stats, but can imagine the women when things weren't good for aborginal women of australia and those black americans etc, they may have been told their milk was no good. To stop breast feeding so they could continue working without a child attached (and more reasons) ... I think the problem now is only re-education, and that it must be already on the rise because those attitudes etc no longer exist. A hard road though - to reigniting the flames for all women to pass on to their daughters after it was doused for generations.Keep up the good work! While many deny racism being around now, we are still suffering the consequences of white forefathers in early times.

About the black mothers dying around giving birth to their child - African americans at least, have a higher rate of blood clots. Im not exactly sure if this is true with africans who havent mixed with other africans/europeans/asians. this is one reason why doctors like to know if people have african blood lines when it comes to birthing and such.

As far as education goes, being white and growing up in southern california i was never told about breast feeding, there was a lot of advertisments for formula and all my friends used formula...

thankfully my mom breastfed and i wasnt interested in spending every last penny on the white gunk. When i told my friends about it, they told me i was nuts and acted like i was giving up my life...

Sex education is trash they dont teach enough about ovulation. It's used as a scare tactic to tell children to abstain from sex instead of how to chart their cycle/the emotional bond between a mother and child and how a child should be raised. I remember we had to drag a doll around highschool that never stopped crying. thats how we were taught what babies did, unless you were lucky like me and had a mom who said different. Not many mom's have those skills that have been lost over generations

same with male circumcision. fathers no longer know how to care for their son's intact penis and mothers no longer know how to feed with their breasts. truly sad

Healthier babies. More secure children. More bonded, loving mothers. It's worth it. It is sooo worth it! Besides, folks, it's cheaper than paying for formula AND builds stronger immunity systems, so less sickness (missed work) in the future. Do it for yourself. Do it for the babies. Do it for your wallet and future sanity.

I've heard quite a few young black women say they think it's gross. Or that they didn't have the support.I've breastfed all 3 of my children. The youngest is just 10 weeks old. Seems the more kids I have, the longer we breastfeed.

I don't really know how to get the word out to the black community about breastfeeding. I know WIC gives the checks for formula so they don't have to pay for it.So saying that breastmilk is free when you can get formula free through WIC isn't much of an argument.

We need to get to these women while they are pregnant. I wish I could start something here in my own community, and maybe I will! I would love to get out to the hospitals, or even host an event in my house.

Breastfeeding is beautiful. I wish all mothers and babies could share that bond.

When working in L&D I noticed that black mothers were less likely to breastfeed. Eben the older, well-educated moms. One day, we had a really nice woman come in, she was in labor with her 3rd child and a lot of her family was with her. They were so supportive, and when it came time to feed him the mother said no, she wouldn't be breastfeeding. So we gave her a bottle of Similac Advance. All of the female family members gathered around the baby were impressed by that...Similac "Advanced". The aunts and grandmother oohed and ahhed over it, while the younger aunt and the sisters looked on. And I just thought...wow...this is how it happens. This is how formula feeding becomes the norm.

I've since seen it happen with all races and ethnic types, so believe me, this isn't an exclusive phenomenon. But whether it's because more black women are supported by their older female family members or the reasons stated in this article...or both...it does happen. Our culture in general isn't very supportive of breastfeeding and change happens slowly.

I was forwarded this link by the Leaky B@@b. Until I saw the title, it never occurred to me that I have NEVER seen a black woman nurse a child in my presence. I have seen pictures - most being recently - but the majority of those are either older or they were taken in a country other than the USA. I plan to breast feed my child (due in November) and have always I would breast feed, but for the life of me I don't know when I decided to do this, as I have never had a role model to teach me. Best wishes to those who are trying to make changes in this area! I think it's one of THE most worthwhile causes we can undertake right now.

The book "At the Breast: Ideologies of Breastfeeding and Motherhood in the Contemporary United States" by Linda M Blum includes an examination of the bfing rate disparity in different economic and racial groups.

Her analysis is challenging, interesting and definitely worth a read. I recall her describing the influence of work, of slavery's legacy, and of societal attitudes towards the bodies of black women. The third point was most interesting to me. I'm not sure I can do justice to her research, but I definitely recommend reading it. She talks about how society regards black women's bodies as highly sexualized and in need of 'regulation'. That there is more of an imperative for black women to keep lines between sexuality and motherhood very crystal clear. Thus the "gross" comments.

This is really sad but true, especially among those around my age (I'm 23). I breastfed my little one until she self-weaned at 3 months but I didn't really have a lot of support besides my DH and my grandmother who breastfed 3 babies. Everyone looks at formula as being so "convenient" when it isn't! I don't have to worry about if my boobs are the right temperature or if I have the right equipment. I miss breastfeeding but I plan to go as long as possible when future kiddos.

I feel like science is a bit behind the curve. Most people know that breast feeding is a good thing. And suzanne lets not blame it on slavery. I am pretty sure the southern democrats didnt supply free formula to the slave women. So they would have had to breast feed. Feminism and welfare (free formula) combined in the 60'-70's to drive millions of women away from breast feeding. So they could get back to work and "be all they can be". And keep their figure.Good chance that less blacks and latinos breast feed because a higher percentage of them are on social services?Also stats show that since the 80's allergies like peanuts have increased 300%. Might take a look at what the gov. is putting in the free formula. As a cattle producer we know that colostrum in the first 48 hours will dramatically reduce disease and sickness throughout life.